• ACT 168

    Please complete all section 1 (for your current employer and any previous employers in which you had direct contact with children) and sign page 2 of this form.

    This form is a requirement for applicants to PA schools.  Applicants must complete a form for their current employer and any former employers where they were in direct contact with children.  The applicant completes section 1 signing on page 2 and then submits these forms to Rachel Prosser, Berlin Brothersvalley School District, 1025 Main Street, Berlin, PA  15530. The school is then responsible to send these forms to each of the employers.
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